Urology
Prostate Cancer
전립선암
Adenocarcinoma arising in peripheral zone of prostate (most common)
- How common
- 4th most common cancer in Korean men
- Typical age
- Most common >60
What is it?
Androgen-dependent peripheral-zone adenocarcinoma; progresses from PIN to invasive cancer; bone metastasis common.
Commonly affected: Prostate peripheral zone; mets: bone, lymph nodes
How it develops
- Genetic/environmentalBRCA2, family history, high-fat diet
- Prostatic intraepithelial neoplasiaAtypical intraductal proliferation
- Local invasionBegins in peripheral zone → capsule invasion
- MetastasisBone (lumbar/pelvis) and lymph nodes predominant
Symptoms
- Bone painLumbar/pelvic with bone metastasis
- Obstructive LUTSBPH-like in advanced disease
- Hematuria/hematospermiaAdvanced disease
- Weight lossAdvanced systemic disease
- Often asymptomaticDetected by PSA screening
How it is examined
- DREHardness, nodules, asymmetry
- PSA + free PSAPSA >4 or rising; free/total <15% concerning
- TRUS-guided biopsy12-core targeted biopsy
Imaging
Multiparametric MRI standard; PI-RADS scoring.
- PI-RADS 4-5 lesion
- EPE
- Seminal vesicle invasion
PSMA-PET/CT for metastatic staging.
- Osteoblastic bone mets
- Lymph node mets
Non-surgical care
- Active surveillanceLow-risk: serial PSA, MRI, biopsy
- Androgen deprivation therapyGnRH agonist (leuprolide), castration
- AntiandrogensCombined with ADT or for castration-resistant
- Docetaxel chemotherapyMetastatic, castration-resistant
- PARP inhibitor (olaparib)BRCA-mutated
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Localized intermediate/high-risk, life expectancy >10 yr
Procedures that may be discussed
- Robot-assisted radical prostatectomy
- External beam RT
- Brachytherapy
- Focal HIFU
Outlook
Localized 5-yr survival >99%; metastatic ~30%; may progress to castration-resistant.